PTSD Isn't Just A War Wound; Teens Suffer, Too

Dr. Amit Etkin and a research assistant help a participant into the bore of the MRI.

Courtesy of the Etkin Lab at Stanford University

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Originally published on August 17, 2012 4:38 pm

Though post-traumatic stress disorder is often associated with war veterans, many sufferers have yet to finish high school.

According to the National Survey of Adolescents, about 4 percent of teenage boys and 6 percent of teenage girls meet the clinical definition of PTSD.

But adolescents can be hard to diagnose.

'A Total Nightmare'

The night Stephanie Romero turned 23, she and a friend were attacked by a stranger.

"My friend went outside to have a cigarette, and there was this guy — he came out; he was harassing us," she says.

The man hit her and her friend, leaving Romero shocked.

"It was just a total nightmare," she says. "I think about it all the time. I've never gone through anything like that."

After the attack, Romero's friends and family noticed she was acting differently. She didn't go out as often. Her weight started changing. She was really depressed. Later, doctors diagnosed her with post-traumatic stress disorder.

"I was like, PTSD? I thought it was just for veterans," Romero says. "But I found out it's not; it's for anyone who's experienced an event where you keep thinking about it and it takes over your life."

A Chemical Called Cortisol

I can relate. When I was 15, my mom was murdered. I tried everything I could to deal with my feelings, including writing songs.

But still, something was different about me. I noticed that I didn't feel like my normal self anymore, not only mentally, but physically. I was losing weight, and my hair was falling out.

"That's a pretty clear symptom that things aren't going well," says Jamal Harris, a pediatrician at a community health center in San Francisco. Harris says he sees teens with PTSD at his clinic all the time, and that many of them have physical symptoms related to their stress.

"Some examples in teens would be problems sleeping, weight gain, and just being frustrated," Harris says.

It turns out a lot of those changes are due to hormones your body makes in response to stress. This can be a good thing. For example, if a car comes at you all of a sudden while you're crossing the street, your body produces a chemical called cortisol, which helps you react fast enough to move before the car hits you.

But for people with PTSD, such as Stephanie Romero and me, it doesn't take a speeding car to set us off.

Emotional Connections In The Brain

In a lab at Stanford University, scientists are using a technology called Functional Magnetic Resonance Imaging, or fMRI, to study the emotional reactions of patients with PTSD.

"So we know, for example, when they're faced with a reminder of their trauma, they don't activate the circuitry we normally associate with emotional regulation, the ability to be resilient in an automatic effortless fashion," says Dr. Amit Etkin, the project's lead researcher.

He says cortisol — that's the same stress hormone that causes physical changes in the body — may also be responsible for the changes in the brain.

"Over time, elevated cortisol can cause death of neurons in the brain, the kind that don't get replaced," he says.

But that doesn't mean PTSD can't be treated. Scientists know talk therapy can be helpful. Etkin wants to understand how that kind of therapy might be repairing emotional connections in the brain. And he's recruiting volunteers.

The Blink Of An Eye

Stephanie Romero is one of the research subjects participating in the study. Ten months after her attack, she's still having trouble feeling safe.

"It's always in the back of my head. Like, you just never know your life could change in the blink of an eye," she says. "One minute you could be celebrating your birthday, and the next you're in the hospital and you don't know how you ended up there.

In a room on the other side of a huge glass window, Romero lies in an fMRI machine, which looks like a big tube with a small hollow center. A monitor shows different angles of her brain.

"A lot of what we look at with emotion is focused on certain regions of the brain. One of them is the amygdala, which is really important not only for guiding your attention and focus on a threat stimulus, but also for affecting your body," he says. "But somebody with PTSD doesn't activate that circuitry well."

Etkin asks Romero several questions to help him identify which specific parts of the brain are affected by PTSD, and how she feels throughout the experiment.

"Does she feel in her body at the moment, or is she feeling, like many PTSD patients report, feeling a little out of body, or detached, or unreal?" he asks.

I can relate to that unreal feeling. It started to hit me right there in the lab. Etkin hopes by understanding how that feeling plays out inside the brain, scientists will be able to come up with more effective ways of treating this disorder, whether it's through singing, talking, neuroscience, or all of the above.

The audio for this story was produced by Youth Radio.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

We tend to hear about post-traumatic stress disorder, or PTSD, in relation to war veterans. But many sufferers here at home haven't yet finished high school. According to the National Survey of Adolescents, about 4 percent of teenage boys, and 6 percent of teenage girls, meet the clinical definition of PTSD, though adolescents can be hard to diagnose.

Eyama Harris, from Youth Radio, reports on young people living with PTSD.

EYAMA HARRIS, BYLINE: On the night of Stephanie Romero's 23rd birthday, she and her friend were attacked by a stranger.

STEPHANIE ROMERO: My friend went outside to go have a cigarette. And there was this guy; he came out, and he was harassing us and...

HARRIS: Stephanie says the man hit her and her friend. She was shocked.

ROMERO: It was just a total nightmare. I think about it all the time, and I just - it was - I've never gone through anything like that.

HARRIS: After the attack, Stephanie's friends and family noticed she was acting differently. She didn't go out as often. Her weight started changing. She was really depressed. Later, doctors diagnosed her with post-traumatic stress disorder, or PTSD.

ROMERO: I'm like, PTSD? I thought it was just for veterans. But I found out, it's not. It's for anybody who's experienced any kind of - you know, event where you can't get it out of your mind; it takes over your life. And that's kind of what has happened to me.

HARRIS: I can relate. When I was 15, my mom was murdered. I tried everything I could to deal with my feelings, including writing songs.

(Singing) Dry my tears and kiss me goodnight...

But still, something was different about me. I noticed that I didn't feel like my normal self anymore - not only mentally, but physically. I was losing weight, and my hair was falling out.

HARRIS: Jamal Harris is a pediatrician at a community health center in San Francisco. He says he sees teens with PTSD at his clinic all the time, and that many of them have physical symptoms related to their stress.

HARRIS: Some examples of symptoms, especially in teens, will be problems sleeping, weight gain, and just being frustrated.

HARRIS: It turns out a lot of those changes are due to hormones your body makes in response to stress. This can be a good thing. For example, if a car comes at you all of a sudden while you're crossing the street, your body produces a chemical called cortisol, which helps you react fast enough to move before the car hits you. But for people with PTSD - like Stephanie and m - it doesn't take a speeding car to set us off.

In a lab at Stanford University, scientists are using a technology called functional magnetic resonance imaging - or fMRI - to study the emotional reactions of patients with PTSD.

DR. AMIT ETKIN: So we know, for example, when they're faced with a reminder of their trauma, that they don't activate the circuitry that we normally associate with emotional regulation - the ability to be resilient in an automatic, effortless fashion.

HARRIS: That's the lead researcher, Dr. Amit Etkin. He says cortisol - that's the same stress hormone that causes physical changes in the body - may also be responsible for the changes in the brain.

ETKIN: Over time, elevated cortisol can cause death of neurons in the brain - the kind that don't get replaced.

HARRIS: But that doesn't mean PTSD can't be treated. Scientists know talk therapy can be helpful. Etkin wants to understand how that kind of therapy might be repairing emotional connections in the brain, and he's recruiting volunteers.

UNIDENTIFIED WOMAN: Great job, Stephanie. How you doing?

ROMERO: Um, OK.

UNIDENTIFIED WOMAN: You're OK? Alrighty.

HARRIS: Stephanie Romero is one of the participants in Dr. Etkin's study. Ten months after her attack, she's still having trouble feeling safe.

ROMERO: It's always in my - back of my head. Like, you just never know; your life could change in like, a blink of an eye. You know, you could one minute be celebrating your birthday; the next, you know, you're in the hospital and you - you know, you don't know how you ended up there.

HARRIS: In a room on the other side of a huge glass window, Stephanie lies in an fMRI machine, which looks like a big tube with a small, hollow center. I sit in front of a monitor as Etkin shows me different angles of Stephanie's brain.

ETKIN: A lot of what we look at, with emotion, is focus on certain regions of the brain. One of them is the amygdala, which is really important not only for guiding your attention and focus on a threat stimulus, but also for affecting your body. But somebody with PTSD doesn't activate that circuitry well.

HARRIS: Dr. Etkin asked Stephanie several questions to help him identify which specific parts of the brain are affected by PTSD, and how she feels throughout the experiment.

ETKIN: Does she feel, in her body, at the moment? Or is she feeling like many PTSD patients report; feeling a little out of body, or detached, or unreal.

HARRIS: I can relate to that unreal feeling. It started to hit me, right there in the lab. Etkin hopes, by understanding how that feeling plays out inside the brain, scientists will be able to come up with better ways of treating this disorder - whether it's through singing, talking, neuroscience, or all of the above.

For NPR News, I'm Eyama Harris.

(SOUNDBITE OF MUSIC)

BLOCK: That story was produced by Youth Radio. Transcript provided by NPR, Copyright NPR.